Perceptions & implications of stigma among HIV positive SRH clients in Kenya

Background: Researchers have widely documented the pervasiveness of HIV stigma and discrimination, and its impact on people living with HIV and their families. Few studies have analysed the perceptions of HIV positive clients accessing sexual and reproductive health (SRH) services. This study explores the experiences of stigma of HIV positive clients attending SRH services and implications for service use and treatment adherence.

Methods: In-depth interviews were conducted with 53 HIV positive women attending SRH services in two districts in Kenya. Data were coded using Nvivo 8 and analysed using a thematic analysis.

Results: Findings show that many HIV positive women report high levels of ‘internal' or felt stigma, resulting in a desire to hide their status from family and friends for fear of discrimination. While no physical/sexual abuse was reported, psychological problems were prevalent. Experiences of felt stigma seemed to be exacerbated by providers' advice to stop breastfeeding at 6 months, contrary to official policy of cessation at 12 months, exposing them to further discrimination by neighbours and families. Importantly, the findings suggest a link between HIV support groups and high self-worth, likely to result in better health-seeking behaviour and treatment adherence.

Conclusions: The findings highlight that ‘internal' stigma leading to low disclosure and poor adherence is widespread and sometimes reinforced by health providers. This has serious implications for drug adherence - and thus HIV prevention and treatment. Promotion of HIV support groups that enhance self-worth among HIV positive clients could result in better health outcomes.